IDRR APRIL -MAY -JUNE 2020 - Flipbook - Page 56
INFECTION CONTROL
religious belief systems rather than from evidence
based scientific backing. The treatise “Charaka
Samhita” a Sanskrit textbook on ancient medicine
clearly outlines the pre-requisites for constructing an
ancient hospital
Ancient Jews, in the small hospitals provided by them
practiced infection control based on the sacrosanct
application of the laws of Leviticus – A book in the
bible. Remains of the “Valetudinaria”- Ancient roman
hospitals for the army, suggest that high standards
were maintained by the Romans as well. The fall of
the Roman empire marked the onset in the decline of
Infection control in the European world – mainly owed
to the primitive life of the barbarian population that
existed then
The Advent of Christianity and the early Christian
church was unique among great religions in being
opposed to washing and caring for the body. Beliefs
and preaching even led to the propagation of the
idea by St Jerome (4th century AD) that “he who has
washed in Christ need never wash again(2)
MEDIVIAL ERA (5AD – 15 AD)
Infectious diseases were of key importance in impacting
the life of people in the medieval ages (3). More than
one third of the people of medieval Europe were killed
by bubonic plague between 1347 and 1350. A less
dreadful 1471 plague outbreak wiped out nearly 15%
of the British population as well. In 1532, during the
reign of King henry VII, London was severely affected
with plague and active throughout England.
The pioneer European hospitals were established
across Europe by religious orders in the 12th century
AD. During those times, the hospitals were knows to
be “spittle houses” that functioned as care homes for
the sick, destitute & insane (4). In the 13th century AD
Theodoric of Bologna refuted with the current teaching
of those times that pus was a prerequisite for wound
healing. He is reported to have cleansed the wounds
and debrided the wounds and sutured them to avoid
contamination(5).
Surgery was the domain of
July-August-September 2019
barbers, or rather barber surgeons and was
performed without asepsis or anesthesia. Postoperative mortality rates of 60% to 80% were quite
common with most mortalities arising as a sequalae
of “hospital” (streptococcal) gangrene. The dressings
used were ground remains of mummified bodies,
ground rabbit fir, with crude attempts in asepsis
THE EARLY MODRN ERA
(1500 AD – mid 1800 AD)
During this period, Plague was no longer a disease of
concern, but infectious diseases topped the list with
most mortalities. The early 1800’s again witnessed
massive outbreaks of cholera with about half of the
infected patients dying (6) (7).
In the 1500’s Ambrose par postulated the school of
thought of gently manipulating traumatic wounds.
Relying mainly of the principle of debridement of
devitalized tissue, application of simple dressings and
did away with the routine use of boiling oil and the
red-hot cautery iron. Even today, his words are
quoted that “I dressed him & God cured him. It was
Madame Necker who put forth and implemented the
suggestion of nursing the sick in single beds, where 6
or 8 were being nursed in a single bed at that point in
time(8)
In 1795, Edward Gener’s first primitive attempt of vaccination is considered to be a landmark in preventive
medicine. He inoculated a boy’s hand with blisters
from a milkmaid’s hand who had cowpox. The boy
then successfully withstood a smallpox challenge
demonstrating immunity (9). Later on, in 1795, The
French council of health drew up a very comprehensive
series for instructions for the prevention of hospital
infection which encompassed of sensible rules for
maintaining the celebrity and purifying the air of the
wards of hospitals
By the late 1700’s around 20000 patients per annum
were hospitalized in London alone and a pioneer
hospital exclusively for infectious diseases were
established(10). History states that the first patient
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